healed rapidly. About February 8, 1888, she was bitten in the face and neck by the same dog, which was then killed: About March 1, she began to behave strangely, and Dr. McNichol "at once discovered that she had symptoms of hydrophobia." March 7, she began biting like a dog, and became frantic at the sight of water. She tried to bite the doctor and had to be tied down. Opiates "had no effect upon her." Death occurred March 8, 1888.-Philadelphia Evening Telegram, March 10, 1888. CASE XV.-Boy (Arthur Tates, near Carthage, Illinois), eight years old. Bitten March 27, 1888, on the face, by a large shepherd dog, which afterwards attacked a man and escaped. The wound was carefully cauterized. April 26, he acted strangely, and soon had spasms and snapped and bit and went into convulsions at sight of water. Physicians were called and said he had rabies. The boy was tied to the bed and held by three men, and was given "powerful opiates, which did not allay the awful spasms." Death occurred April 29, 1888.-New York Herald, May 1, 1888. The tabular statement of the foregoing cases, which I have prepared, will spare me the trouble of a detailed analysis. But, I would call your attention to a few points which have impressed me in studying it. 1. The effect of anticipation of hydrophobia. This is said to have been present in seven of the fifteen cases, and may be suspected in more. 2. The lack of evidence of rabies in the animal which did the biting.-Not one of the animals furnished more than ground for a suspicion that it was rabid. The fact that a fighting dog bites a man who interferes with it, is no evidence that it is rabid, nor is the manifestation of a vicious temper a good evidence of rabies. The same may be said of death in a fit. 3. The effect of a diagnosis of hydrophobia.In ten of the fifteen cases it is stated that the physicians made an early diagnosis of hydrophobia, and presumably they failed to conceal the fact from the patient. 4. The effect of applying the test of the water.This is said to have been done in seven of the fifteen cases, and it was probably done in almost all of them. ten of the cases; and they were probably used in all. Curare is said to have been used in four cases. You will, I trust, permit me to think that my prolonged study of hydrophobia has produced something which may be called an opinion-not prejudice-in regard to its nature and treatment; and I should be a coward if I hesitated to express and I should be a coward if I hesitated to express my opinion for fear that I should once more be I have on several previous accused of prejudice. occasions declared my belief that hydrophobia is not a specific inoculable disease. I believe this more firmly to-day than ever before. I do not deny that men and women and children sometimes fall into a peculiar state after a dog-bite, and die in due time. But I do deny that this is attributable to any specific virus in the dog's saliva. The same thing has occurred too often from other causes, to justify one in charging it to a specific virus when it follows a dog-bite. And, I believe that rejection of the specific theory will do more to banish hydrophobia from the world than anything which we have ever heard of. The word "hydrophobia" should be used only to describe a condition-and not a disease-as we use the word "convulsions," and it should be remembered that this condition may be present in a great number of diseases, as I tried to show you when you last met in this city, in 1884. I firmly and honestly believe that if this view of what is called hydrophobia were generally accepted, the disorder would shrink and disappear as the genie is said, in the tales of the "Arabian Nights," to have shrunk and disappeared when the right word was spoken. And, I call your attention to the fact that hydrophobia is now almost unknown in our own State of Pennsylvania. Not a single case has occurred in our State since we last met, and I cannot but attribute this fact partly to the extent to which your judgment confirms the opinions to which my studies of hydrophobia have led me. I do not despair of seeing the belief in hydrophobia follow the belief in witchcraft, which once had the support of Church and State, of the medical profession and the laity, but which now, thank God! torments our fellow-men no more. So long, at least, as Pennsylvania presents the spectacle of freedom from the thraldom of ancient superstition, in regard to hydrophobia, and freedom from its curse, I cannot but think that the former has some causal connection with the latter. Correspondence. OUR NEW YORK REPORT. From ur own Correspondent NEW YORK, April 25th. RECENT METHODS OF TREATING RETROFLEXION OF THE UTERUS. The treatment of this important affection of the uterus during the last few years has undergone a complete revolution. The pessary seems to be on the eve of discardment, for one will see many cases of this displacement at the hospitals and clinics before he will have the opportunity of seeing a pessary introduced for the relief or cure of it. The shortening of the round ligaments or Alexander's operation, and the more recent one of hysterroraphy have taken its place. The main pathological lesion of retroflexion is now regarded as a lengthening or stretching of the round ligament which holds the uterus in its normal position of slight anteversion and anteflexion. If this view be correct it is obvious that the pessary can no longer be regarded as a curative measure, and some plan must be adopted which corrects the pathological lesion itself and thus at once effect a complete cure. As to the correctness of this view there can now be but little doubt, for it has been demonstrated time and time again, both on the living subject and the cadaver, whereby from the simple process of short_ ening the round ligaments, the retroflexed uterus has been made to occupy its normal position. Gynecologists now believe, that in the operations of Alexander and hysterroraphy, they have at once found a rapid and rational method of cnre. To Prof. Polk is due the credit of having first performed and demonstrated the advantages of Alexander's operation in America. Hysterroraphy was first suggested by Marion Sims; Sänger of Leipsig advanced the technique of the operation to its present status, and finally Dr. Kelly of Phila. delphia, gave it the name which it now bears. From different and varied sources the following appears to be the limitations of each operation. Alexander's operation is to be preferred in all those cases in which the uterus is retroflexed and can be readily replaced by the sound or fingers, and in which no adhesions are found to exist, if there are adhesions it is worse than useless. It can also be performed for retroflexion of the uterus accompanied by prolapse of the ovaries and prolapsus uteri. Hysterroraphy is to be preferred in those cases where the uterus is bound down and adherent, and especially in those most intractable cases in which the retroflexion is accompanied by prolapse of the ovaries and tubes, and the whole adherent and matted together. In such cases the adhesions must first be separated, and then the uterus secured in position; if the tubes and ovaries are much diseased they had better be removed before the uterus is fixed. In cases of prolapsus uteri the general opinion is that it is to be preferred to Alexander's. The following is the method in which Professor Polk performs the Alexander's operation, and which your correspondent had the opportunity of seeing: The patient is placed on the back, lower part of the abdomen is washed with soap and water, shaved, then douched with 1-2000 bichloride, and finally washed with ether. The incision Prof. Polk prefers is one just above the spine of the pubes, and extending for 1 inches on either side of the median line; all the tissues are then carefully dissected with a scalpel, so that the external inguinal rings on both sides are displayed. Another method of making the incision is to start just above the spine of the pubes, and to run upwards and outwards parallel to Poupart's ligament to the extent of two inches on either side; this, however, necessitates two incisions, and has no advantage over the single one. The external rings having been displayed, the round ligament is carefully sought for in the mass of fat occupying the opening of the ring, picked up with a pair of forceps and carefully drawn out to the extent of two inches on both sides. If the finger is now introduced into the vagina the uterus will be found to occupy its normal position. The ligaments are stitched with catgut to the edge of the external rings and pubes, and the superabundant two inches may be cut off with scissors, or else interlaced and stitched to the same portion of the opposite ligament. The wound is then irrigated with 1-2000 bichloride, a small drainage tube inserted, stiched with catgut and dressed with iodoform and Theirsch gauze. Prof. Lusk performs hysterroraphy as follows: Patient is placed in the dorsal decubitus, abdomen carefully washed with soap and water and shaved. Then it is douched with 1-2000 bichloride and finally cleansed with ether to remove all oleaginous material. An incision is then made in the median line about two inches in length, just above the pubes, and the tissues carefully cut through until the peritoneum is reached. All hæmorrhage is then arrested with clamps, etc., the peritoneum picked up between two artery forceps and incised. The finger is then introduced into the peritoneal cavity and the position of the uterus made out. If there are no adhesions it is simply brought up to the abdominal wound, and a curved needle armed with silk is then passed through the broad ligament just external to the cornua, so as to include only the round ligament, (this point is not essential, as the round ligament may be secured at any point in the broad ligament and at a considerable distance from the uterus). The needle is then The needle is then passed through the anterior abdominal wall at the side of the incision, just above the pubes, to the extent of one quarter inch in depth and then tied. The other side is treated in a similar manner; thus we have the uterus firmly held upwards and forwards by the round ligaments being firmly fixed to the anterior abdominal wall. The peritoneum is then sewed up with medium-sized catgut, and the remaining tissues with silk, and the wound dressed antiseptically. If there are adhesions between the posterior surface of the uterus and the peritoneum, they are broken up with the finger; if the tubes and ovaries are found sufficiently diseased they are removed, the uterus secured as above and all hæmorrhage checked with hot water, (115°). The peritoneal cavity is now sponged dry and closed. If, however, there is considerable oozing, a glass Bantock drainage-tube is inserted well down into the pouch of Douglas and left there for forty-eight hours, and the peritoneum and other tissues sewed up in the same manner. The glass tube is exhausted every one or two hours, as may be necessary, until the oozing has stopped, when it is removed. Alexander's operation is the more popular, for the simple reason that it is extra-peritoneal and as devoid of danger as the simple operation of trachelloraphy. Hysterroraphy is attended with all the dangers of a laparotomy, and although these have been reduced to a minimum by the specialist, still it will be doubtless some time before the general practitioner performs it for simple retroflexion. The interesting question has been raised that, should patients on whom these operations have been performed become pregnant and subsequently be delivered, what would be the position of the uterus after delivery? Alexander's operation has been performed on patients who subsequently were delivered of children, and the uterus was found to be in good position. As yet no such report has been made on a hysterroraphy case. OUR LONDON LETTER. To the Editor of the CANADA LANCET. SIR, I think that the discussion which took place at the meeting of the Royal Medical and Chirurgical Society on Tuesday evening last, may be of some interest to your readers, as it touched upon a point which, as far as I am aware, has not hitherto been suggested by any English writers, and has only been hinted at by one continental author, viz., the clinical significance of claycolored stools, unaccompanied by jaundice, in their connection with diseases of the pancreas. Dr. T. J. Walker, the author of the paper read before the Society, just referred to the hitherto universally accepted view that the presence of clay-colored stools always indicated some disorder of the liver. He then cited two cases which he had had under observation through several years of their lives, and on which subsequently, necropsies had been made; in both of which large, greasy, clay-colored stools had been continuously passed for some years, and in which no symptoms of biliary derangement were present; on postmortem examination both cases were found to have occlusion of the pancreatic duct accompanied by fatty degeneration of the pancreas. The liver and biliary apparatus in both cases were healthy. From these cases he suggests the theory, that the formation of the coloring matter of the fæces, hydrobilirubin, depends not upon the bile alone but upon the mutual reaction of the bile and pancreatic juice upon each other in the intestinal canal. Secondly, that a deficiency of pancreatic juice will equally with a deficiency of bile, produce clay-colored stools. Thirdly, that, as hydrobilirubin is that part of the biliary products excreted in the fæces, and that as its formation depends on the pancreatic secretions, so the pancreas plays an important part in the excretion and absorption of bile in the intestinal canal. Dr. Walker then pointed out that these views if accepted, would explain the hitherto inexplicable cases where there was no evidence of arrest of the bile secreting functions of the liver, and where no obstruction to the outflow was present, but when clay-colored stools persistently existed. It also served to explain, if accepted, the discrepancies between the clinical observations that certain drugs, calomel, for instance, produce bilious stools, and the physiological observations that these drugs have no influence on the secretion of bile by the liver. In the discussion which followed Dr. Harley drew attention to the fact that several well-authenticated cases of colorless bile had been reported, and that the cases reported might depend on this fact. Dr. Walker, moreover, pointed out, that at the necropsy, in both cases, ordinary bile was found in the gall bladder. Dr. Walker's paper certainly opens up a new field for clinical observation; but I think that two cases, however well marked, scarcely furnish sufficient foundation on which to base so radical a change in our views on the pathology of clay-colored stools. Still, an important point has been raised, which, I feel sure will be well worth receiving some attention at the hands of our Canadian practitioners. R. ADAM WALKER. 34 Harrington Square, N. W., London, April, 10th, 1889. Selected Articles. COMPLETE OBSTRUCTION OF THE COLON SUCCESSFULLY RELIEVED BY USING SENN'S PLATES-A PROPOSED SUBSTITUTE OF CATGUT RINGS. BY ROBERT ABBE, M.D. It has been with pride and gratification that surgeons here and abroad have watched the zealous and tireless energy of our countryman, Dr. Nicholas Senn, in his experiments to determine the value of certain expedients in rendering safe and sure the repair of injuries of the intestines. After reading the published account of his exfor the current year, I doubt not most of us felt conperiments detailed in the "Annals of Surgery" vinced that an important help had been rendered to the understanding of the action of repair and the assistance we might advantageously give. Senn offered one device for use in the restoration 'Without making extravagant statements, Dr. of the intestinal canal when complete obstruction had occurred that, it may be hoped, will replace the tedious, difficult, and frequently fatal operation of circular enterorrhaphy-namely, the apWhether proximation plates of decalcified bone. it be in chronic obstruction, from neoplasms or stricture of the bowel, or in acute injury of the FIG. 1.-Senn's approximation plates. intestines from laceration with its accompanying shock, the vital condition of the patient is never so good that one does not fear for the result, especially if the shock of an operation is added, which in most experienced hands, cannot be completed in less than from an hour and a half to two hours and a half. We welcome, then, a method that with greater certainty and less shock completes, in from a quarter to a third of the time, the coaptation of openings made in the bowel on either side of the obstruction, and establishes a continuous intestinal canal. Such a work is accomplished by Senn's plates. The principle is not entirely new, but its successful application had not been demonstrated until his experiments upon dogs put it upon a working basis. How far it can be relied upon in man has yet to be proved. The principle, briefly stated, is to substitute for the tedious stitching of the lips of two longitudinal |